Peripheral Vascular Disease

The nurse is performing a nursing assessment for a client with PVD. Which data should the nurse collect during the health history? SATA A) Current diet B) Presence of skin discoloration C) Current medications D) Hx of coronary artery disease E) Presence of pain

A, C, D, E Rationale: During the health history portion of the nursing assessment for the client with​ PVD, the nurse will assess client history of coronary artery disease​ (CAD), current medications and​ diet, and any complaints of pain. Presence of skin discoloration would be assessed during the physical exam portion of the nursing assessment.

A client diagnosed with PVD is obese, has a 30-year history of cigarette smoking and works as a contractor. When discussing risk factors for PVD which statement by the nurse is appropriate? A) "Nicotine causes vasospasms, which reduce blood flow to the legs." B) "Obesity is a factor in cardiovascular disease but not peripheral vascular disease. C) "Nicotine primarily affects coronary arteries and the lungs." D) "Your current occupation is a major risk factor."

A) "Nicotine causes vasospasms, which reduce blood flow to the legs." The vasoconstrictive properties of nicotine will worsen the client's PVD by further decreasing peripheral blood flow. One of the most important parts of treatment is the cessation of cigarette smoking. The client's occupation is not a risk factor related to PVD. Obesity is a risk factor for both cardiovascular disease and PVD; however, the nurse should focus on smoking cessation as a first priority with this client.

The nurse is assessing a client diagnosed with chronic vascular insufficiency (CVI). Which assessment finding should the nurse expect? SATA A) Lower extremity edema B) Soft subcutaneous tissue on affected areas on leg C) Excessive hair growth on the legs D) Cyanosis of lower legs E) Pale skin on lower legs

A, D Lower extremity edema Cyanosis of lower legs ​Rationale: Manifestations of CVI include lower extremity edema that worsens with​ standing; itching, dull leg discomfort or pain that increases with​ standing; thin,​ shiny, atrophic​ skin; cyanosis and brown skin pigmentation of lower leg and​ foot; possible weeping​ dermatitis; thick, fibrous​ (hard) subcutaneous​ tissue; and recurrent ulcerations of medial or anterior ankles.

What causes brown pigmentation of the lower extremities in clients with venous stasis? A) The necrosis of subcutaneous fat due to tissue hypoxia B) Breakdown of red blood cells in the congested tissues C) Reduced inflammatory and immune response from congested circulation D) Skin atrophy caused by lack of circulation.

B) Breakdown of red blood cells in the congested tissues Rationale: Breakdown of red blood cells in the congested tissues causes brown skin pigmentation. While the other choices may occur with peripheral vascular disease, they are not responsible for the cause of brown pigmentation to the skin

A nurse is teaching a client about aspirin for PVD. Which client statement indicates that teaching has been successful? A) "This medication will open my arteries and increase blood flow to my legs." B) "This medication will thin out my blood so it flows easier." C) "This medication will help decrease the plaque in my arteries." D) "This medication will prevent me from developing a blood clot."

D) "This medication will prevent me from developing a blood clot." ​Rationale: Aspirin, an​ antiplatelet, is prescribed in PVD to prevent clot formation. Aspirin does not​ vasodilate, decrease​ viscosity, or help decrease plaque in the arteries. Pentoxifylline​ (Trental) decreases blood viscosity and Cilostazol​ (Pletal) decreases blood viscosity in addition to preventing further clots.

The nurse is teaching a client about the endarterectomy she will undergo soon for peripheral atherosclerosis. Which statement should the nurse include in the teaching? A) The purpose of an endarterectomy is to vaporize the occluding material. B) An endarterectomy is the first choice of treatment for peripheral atherosclerosis. C) And endarterectomy allows for the placement of a bypass graft. D) The purpose of an endarterectomy is to remove plaque from the artery.

D) The purpose of an endarterectomy is to remove plaque from the artery. Rationale: An endarterectomy is performed to remove plaque from an occluded artery. Laser or thermal angioplasty is used to vaporize occluding material. Surgery is not a first​ choice, but is performed if symptoms are​ progressive, severe, or disabling. Bypass grafts are placed during bypass graft surgery.

Which client has the highest risk of developing PVD? A) 83-year-old African American male B) 78 year old African American Female C) 64-year-old Hispanic male D) 75-year-old White female

A) 83-year-old African American male Rationale: PVD primarily affects older adults, with greater prevalence seen in adults over age 80. Men are more often affected then women. African Americans are at greatest risk compared to other races.

Which form of PVD is characterized by thickening, loss of elasticity, and calcification of arterial walls? A) Arteriosclerosis B) Atherosclerosis C) Chronic venous insufficiency D) Deep Venous thrombosis

A) Arteriosclerosis Rationale: Arteriosclerosis is characterized by thickening, loss of elasticity, and calcification of arterial walls. Atherosclerosis is a form of arteriosclerosis in which deposits of fat and fibrin obstruct and harden the arteries. Chronic venous insufficiency is a disorder of inadequate venous return over a prolonged period. Deep venous thrombosis is the presence of a blood clot in a deep vein.

A client with chronic PVD reports continuous pain in the bilateral lower extremities at rest and has pre-gangrenous lesions on his left foot. The nurse should expect to prepare the client for which collaborative intervention? A) Revascularization surgery B) Intense Pulsed Light (IPL) C) Semirigid boots D) Smoking cessation classes

A) Revascularization surgery ​Rationale: When PVD is severe enough to cause pain with rest and pregangrenous or gangrenous​ lesions, revascularization therapy is likely necessary. IPL and semirigid boots are used to treat stasis pigmentation. Although smoking cessation is vital in the treatment of​ PVD, there is no information in this scenario that the client smokes.​ Additionally, smoking cessation alone will not treat severe PVD.

The nurse is caring for a client with PVD. Which nursing intervention should the nurse implement? SATA A) Encourage exercise B) Encourage frequent position change C) Assess peripheral pulses D) Keep lower extremities warm E) Keep legs in dependent position during sleep

A, B, C, D Rationale: To evaluate and promote tissue perfusion in the client with​ PVD, the nurse should assess peripheral pulses to ensure adequate​ perfusion, keep lower extremities warm to prevent vasoconstriction associated with cold​ temperatures, encourage exercise to increase circulation to lower​ extremities, and encourage frequent position changes to avoid a decrease in circulation to the lower extremities. The nurse should elevate the legs during sleep and rest. Elevation promotes venous return from the​ extremity, increasing circulation and relieving pain.

The nurse is caring for a client recently diagnosed with PVD. Which intervention should the nurse teach the client? SATA A) Elevate the legs when asleep or resting B) Avoid crossing the legs when in a sitting position. C) Encourage wearing knee-high compression stockings. D) Put on above-the-knee elastic hose with the legs elevated E) Avoid walking or standing to allow the legs to rest.

A, B, D ​Rationale: Nursing interventions for PVD include elevating the legs when resting or​ asleep, avoiding crossing the legs or putting pressure on the back of the​ knees, and putting on hose after the legs have been elevated. The client should be encouraged to walk as much as possible. Compression hose should be above the knee and tighter over the feet than the top of the leg.

A nurse is teaching a client diagnosed with PAD about proper positioning of the lower extremities. Which client statement indicates a need for further teaching? A) "I can sit in a chair while I watch television." B) "I will elevate my legs and feet on pillows when I lie down." C) "I will avoid crossing my legs." D) "I should hang my legs off the bed while I am resting."

B) "I will elevate my legs and feet on pillows when I lie down." ​Rationale: Elevation of the affected limb can slow arterial blood flow to the​ feet, so this position should be avoided. The client may sleep with the extremities hanging or positioned upright in a chair. The client is also instructed to avoid crossing the legs because this interferes with blood flow.

A nurse is teaching a client with suspected PVD about segmental pressure measurements. Which statement should the nurse include in the teaching? A) "If you have PVD, the BP in your legs will drop further during exercise." B) "If you have PVD, your BP may be lower in your legs than your arms." C) "This uses sound waves reflected off red blood cells to look at blood flow." D) "We need to do this before surgery to locate and evaluate the blood clot."

B) "If you have PVD, your BP may be lower in your legs than your arms." Rationale: Segmental pressure measurements use a Doppler and sphygmomanometer to compare BPs in the upper and lower extremities. In​ PVD, the BP in the legs will be lower than in the arms. A Doppler uses sound waves that reflect off of RBCs to evaluate blood flow. Angiography is done before revascularization surgery to locate and evaluate the extent of the arterial obstruction. A stress test measures pressures in the lower extremities during exercise.

The nurse performing an assessment on a client with PVD. Which finding should the nurse expect? A) Wheezing upon auscultation of the lungs B) Delayed capillary refill in the lower extremities C) Dilated blood vessels in the eye D) Decreased sensation of the upper extremities

B) Delayed capillary refill in the lower extremities Rationale: Delayed capillary refill in the lower extremities may be present in the client with PVD. The other clinical manifestations are not present in the client with PVD.

A client is admitted to the hospital for a surgical intervention due to peripheral vascular disease. The nurse should be prepared to answer questions about which procedure? A) Stent placement B) Endarterectomy C) Percutaneous transluminal angioplasty D) Atherectomy

B) Endarterectomy Surgical intervention for PVD includes endarterectomy and bypass grafts. All other choices are nonsurgical interventions for PVD.

A client with PVD is experiencing pain. Which nursing intervention addresses the client's pain? A) Elevate legs in bed B) Keep the extremities warm C) Encourage to ambulate several times each day D) Apply cool compresses to the extremities

B) Keep the extremities warm. Rationale: The nurse should help keep the client's extremities warm, as heat promotes vasodilation and reduces pain. Elevating the legs in bed and encouraging the client to ambulate are more appropriate for promoting tissue perfusion and will not immediately address the client's pain. Cool compresses will constrict vessels and cause more pain.

The nurse is planning care for a client with PVD who is at risk for Impaired Skin Integrity. Which intervention is appropriate for the nurse to include in the plan of care? A) Restrict fluids B) Keep the skin clean and dry, and moisturize areas of dryness. C) Encourage bedrest with legs elevated on pillows D) Consult a dietician for low-protein diet.

B) Keep the skin clean and dry, and moisturize areas of dryness. Rationale: The client with PVD who is at risk for impaired skin integrity should have meticulous skin care to keep the skin clean, dry, and well-moisturized to prevent skin breakdown. A fluid restriction would dry tissues and not promote good skin turgor. Bedrest with legs elevated on pillows could increase the client's pain and would not help with preventing skin breakdown. A low-protein diet is not beneficial for wound healing and may not be indicated for this client.

The nurse is completing a physical assessment on a client with edema and pooling of blood in the veins of the lower extremities. The nurse suspects the diagnosis of chronic venous insufficiency (CVI). Which additional assessment finding should the nurse expect to observe? A) Absent pedal pulses B) Skin hyperpigmentation C) Cool feet and toes D) Gangrene

B) Skin hyperpigmentation ​Rationale: Symptoms of chronic venous insufficiency include edema of the lower extremities and hyperpigmentation of the skin of the feet and ankles. Absent​ pulses, cool skin on the feet and​ toes, and gangrene are signs of an arterial​ problem, not a venous problem.

The nurse is evaluating teaching provided to a client with PVD. Which client observation indicates teaching has been effective? A) Sitting in a chair with a pillow behind knees B) Washing the lower extremities with mild soap, drying the legs and applying a light moisturizer. C) Sitting in a chair with left leg crossed over the right. D) Smoking a pipe instead of cigarettes.

B) Washing the lower extremities with mild soap, drying the legs and applying a light moisturizer. Rationale: The client who is observed washing the legs with mild soap, drying the legs, and applying a moisturizer is putting into practice the instruction regarding PVD. Sitting in a chair with a pillow behind the knees or with legs crossed would indicate further instruction was needed. The client smoking a pipe instead of cigarettes needs additional instruction regarding the hazards of tobacco.

The nurse is planning care for an older adult client with chronic venous insufficiency. Which will the nurse include in the client's teaching plan? A) Keep the legs dependent as much as possible and elevate only when asleep. B) Wear elastic hose as prescribed C) Standing will prevent the progression of the disease. D) Cross legs only at the knees.

B) Wear elastic hose as prescribed. Rationale: Care and treatment of a client with peripheral vascular disease includes instruction. The nurse should instruct the client to wear elastic hose as prescribed. The legs should be elevated during rest and when asleep. The nurse should instruct the client to avoid sitting or standing for long periods of time. Crossing the legs should be avoided.

A nurse is examining a client diagnosed with PVD who has an ulcer on the great right toe. Which additional assessment finding should the nurse expect? SATA A) There is pitting edema in the lower extremity B) The toenails are thickened C) There is an absence of hair on the legs D) The extremity is cool to the touch E) There is brown pigmentation of the lower extremity

B, C, D ​Rationale: Wounds on the​ toes, absence of hair on the​ legs, cool​ extremities, and thick toenails are all features of arterial problems. Venous problems are characterized by brown pigmentation of the skin of the lower extremity and edema.

A community health nurse is teaching a group of adults about the risk factors associated with PVD and chronic venous insufficiency (CVI). Which risk factor should the nurse include? SATA A) Male B) Physical inactivity C) Increased cholesterol levels D) Age 45 or older E) Excess body weight

B, C, E Physical inactivity, excess body weight, Increased cholesterol levels. ​Rationale: Risk factors associated with PVD and CVI include increased cholesterol​ levels, excess body weight or​ obesity, and physical inactivity. Clients age 50 and older are at greatest risk for developing PVD or CVI. Males and females are equally affected by these conditions.

A client's daughter asks how to prevent PVD. Which information should the nurse include as a preventative measure? SATA A) Starting blood pressure medications B) Maintaining a healthy weight C) Exercising regularly D) Starting cholesterol-lowering medications E) Quitting smoking

B, C, E ​Rationale: Preventative measures for PVD include maintaining a healthy lifestyle​ (ideal weight,​ exercising), smoking​ cessation, and following treatment for chronic illnesses. It is outside of the scope of the nurse to prescribe blood pressure or​ cholesterol-lowering medications. It is also unknown whether this client requires those medications.​ However, blood pressure and​ cholesterol-lowering medications can help slow or reverse the progress of PVD if taken as ordered by a provider.

A client admitted with chronic venous insufficiency has an infected wound of the left lower extremity. Which clinical manifestations does the nurse anticipate during the client's assessment? SATA A) Pulses absent in the extremity with the wound B) Wound that is pink with skin warm. C) Ulceration that is pale in color D) Skin surrounding the ulcer that is cool to touch E) Surrounding skin brown in color

B, E Wound that's pink and has warm skin Skin surrounding the ulcer is brownish in color. Rationale: Manifestations of a venous status ulcer are a pink wound with warm skin and areas of hyperpigmentation. An ulcer that is pale in color with cool skin temperature and absent pulses is an arterial ulcer.

The nurse is preparing to teach a client with a venous stasis ulcer on the left lower leg. Which intervention should the nurse include in the teaching plan? A) Increased carbohydrate intake to promote wound healing. B) How to keep the wound bed clean and dry. C) Application of elastic compression stockings. D) Purpose of antibiotic therapy.

C) Application of elastic compression stockings. ​Rationale: Use of elastic compression stockings is essential to healing of venous stasis ulcers. High dietary intake of​ protein, rather than​ carbohydrates, is needed for wound healing. Antibiotics are not routinely used for venous ulcers. Moist dressings are used for venous stasis​ ulcers, not dry dressings.

The nurse is evaluating a client that states, "I usually walk 30 minutes every morning, but lately my leg cramps and hurts after just a few minutes. The pain goes away after I stop walking, though." Which action should the nurse do first? A) Notify the healthcare provider B) Ask the client about skin color changes C) Assess the posterior tibial and pedal pulses D) Discuss benefits of daily exercise.

C) Asses the posterior tibial and pedal pulses. Rationale: This client is describing symptoms of intermittent claudication. The nurse should assess the strength and equality of peripheral pulses to determine perfusion. Changes in skin color are important but not the priority. The nurse should complete the assessment before contacting the healthcare provider or discussing the benefits of daily exercise

The nurse is talking to a client with PVD who reports using biofeedback as a complementary therapy. The nurse knows this serves which purpose for PVD? A) Lowering overall cholesterol B) Reducing stress C) Improving peripheral circulation D) Decreasing arterial plaques buildup

C) Improving peripheral circulation Rationale: Biofeedback is used to improve peripheral​ circulation; biofeedback does not reduce plaque buildup. Exercise and a change in diet can reduce overall cholesterol and slow the progress of PVD. Many alternative therapies are used to reduce​ stress, but that is not a main function of biofeedback.

A client with PVD has symptoms of intermittent claudication. Which should the nurse include when teaching the client about intermittent claudication? A) It causes pain that occurs during periods of activity. B) It causes pain that increases when the legs are elevated and decreases when the legs are dependent. C) It causes cramping or aching pain in the lower extremities and the buttocks that occurs with a predictable level of activity. D) It is often described as a burning sensation in the lower legs.

C) It causes cramping or aching pain in the lower extremities and buttocks that occurs with a predictable level of activity. Rationale: Intermittent claudication is a cramping or aching pain in the calves of the legs, the thighs, and the buttocks that occurs with a predictable level of activity. The pain is often accompanied by weakness and is relieved by rest. The other descriptions apply to rest pain, not intermittent claudication.

The nurse is evaluating the goal established for a client with peripheral vascular disease, "The client will learn appropriate foot and wound care." Which outcome demonstrates goal achievement? A) The client's leg wound shows no signs of infection. B) The client informs the nurse that the wound is improving C) The client demonstrates proper wound care techniques to the nurse. D) The client's leg ulcer is showing signs of healing.

C) The client demonstrates proper wound care techniques to the nurse. Rationale: Client goals are​ measurable, specific,​ realistic, and achievable. The client verbalizing proper wound care demonstrates goal achievement. The ulcer showing signs of healing and​ improvement, and no signs of infection are medical outcomes.

A client with PVD asks the nurse what types of exercise would improve the client's condition and overall health. Which type of exercise will the nurse include in the response to the client? A) Passive ROM B) Weight lifting C) Yoga D) Team sports

C) Yoga Rationale: Yoga is considered a complementary therapy used to reduce stress and improve circulation. Active ROM exercises should be encouraged rather than passive ROM exercises. Weight lifting may increase blood pressure and cause harm to fragile blood vessels. Clients with PVD should have gradual increases in duration and intensity of exercise, so team sports would not be appropriate.

A home health nurse is caring for a client with PVD. When teaching the client regarding foot and leg care, which statement should the nurse include? SATA A) "Avoid using powder on your feet." B) "When swimming, ensure the water is cool, not warm." C) "Apply moisturizing cream to feet and legs daily." D) "Dry between your toes after showering." E) "Buy shoes in the morning, when feet are largest."

C, D ​Rationale: Foot and leg care for clients with PVD includes applying moisturizing cream to feet and legs daily as well as drying between the toes after showering. The client should use powder on the feet to keep feet dry. When​ swimming, water should be warm because cool water causes​ vasospasm, worsening the​ client's condition. The client should buy shoes in the​ afternoon, when feet are largest.

The nurse is teaching a client about lifestyle modifications to promote vasodilation in a client with PVD. Which intervention should the nurse suggest? A) Take an aspirin daily B) Wash extremities in cool water. C) Walk daily D) Stop smoking

D) Stop smoking ​Rationale: Smoking causes​ vasoconstriction, so stopping smoking will improve vasodilation. Increasing activity such as walking may lead to collateral circulation but does not cause vasodilation. The use of aspirin may impede platelet clumping but does not cause vasodilation. Cool water may cause vasoconstriction to occur.